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Abstract
ObjectiveTo determine whether the whole-body tumor burden, as quantified by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT), is a prognostic indicator in advanced (stage III or IV) non-small cell lung cancer (NSCLC).Materials and MethodsThis was a prospective study in which we evaluated 18F-FDG PET/CT staging parameters to quantify tumor burdens in patients with stage III or IV NSCLC. The following parameters were evaluated for the whole body (including the primary tumor) and for the primary tumor alone, respectively: maximum standardized uptake volume (wbSUVmax and tuSUVmax); metabolic tumor volume (wbMTV and tuMTV); and total lesion glycolysis (wbTLG and tuTLG). To determine whether the 18F-FDG PET/CT parameters were associated with overall survival (OS) and progression-free survival (PFS), we evaluated the wbSUVmax/tuSUVmax, wbMTV/tuMTV, and wbTLG/tuTLG ratios.Results18F-FDG PET/CT was performed for staging in 52 patients who were followed for a median of 11.0 months (mean, 11.7 months). The estimated median PFS and OS were 9.6 months and 11.6 months, respectively. In the univariate analysis, OS was found to correlate significantly with wbTLG (hazard ratio [HR] = 1.001; 95% confidence interval [95 CI]: 1.000-1.001; p = 0.0361) and with the wbTLG/tuTLG ratio (HR = 1.705; 95% CI: 1.232-2.362; p = 0.0013). In the multivariate analysis, only the wbTLG/tuTLG ratio was independently associated with OS (HR = 1.660; 95% CI: 1.193-2.310; p = 0.0027).ConclusionThe wbTLG/tuTLG ratio is an independent prognostic indicator of OS in advanced-stage NSCLC.
Highlights
Lung cancer is the leading cause of death worldwide[1,2]
All patients with histologically confirmed stage III or IV Non-small-cell lung cancer (NSCLC) were included in the analysis, as were those in whom the histopathology was not able to specify the type of NSCLC
We evaluated 52 baseline 18F-FDG PET/CT scans performed for staging in 52 patients
Summary
Lung cancer is the leading cause of death worldwide[1,2]. Non-small-cell lung cancer (NSCLC) accounts for 80% of all cases of lung cancer, and more than half of all patients with NSCLC have metastatic disease at the time of diagnosis, the 5-year survival rate for all stages combined being 18%(2). A TNM-based stage grouping of I–IV is a prognostic indicator in patients with lung cancer. TNM staging is not able to differentiate between stage III/IV patients with oligometastatic disease and patients with extensive metastatic NSCLC. In the routine clinical setting, the prognosis of stage IV NSCLC that presents as oligometastatic disease may not differ significantly from that of stage III NSCLC[3]
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